NHS could ban life-saving heart device 'because it's too expensive'

A treatment which has saved the lives of tens of thousands of heart patients could be banned on the Health Service because it is too expensive.

Last year, around 40,000 patients were fitted with drugcoated stents - special tubes which are inserted into arteries to prevent them from narrowing.

The system is more expensive than stents that don't include drugs, but are more effective at keeping people out of hospital.

They also avoid the need for heart bypass operations.

Now the National Institute for health and Clinical Excellence has recommended that the devices be banned on the basis of cost.

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The watchdog admits that drugcoated stents are much more effective in preventing the re-narrowing of arteries than cheaper varieties. But it says they are not cost-effective and wants surgeons to use older drug-free stents instead because they are £600 cheaper.

Patients in Scotland will still be able to have the drug-eluting stents on the NHS because NICE's remit only runs south of the border.

Last night, doctors said the guidance will cost the NHS more money because a greater number of patients will have to go back in for repeat operations. Waiting lists would also rise because more people would have to have bypasses, which require a longer stay in hospital.

A recent study showed that patients fitted with drug- coated stents - which have been described as magic bullets - are three times less likely to suffer re-narrowing of the arteries. It means they are much less likely to have to return to hospital for a replacement stent to be fitted - an operation which costs as much as £6,000.

Currently, around 70,000 patients a year receive stents, of which 40,000 are of the drug-eluted variety.

These work by releasing one of a range of drugs designed to prevent the over-growth of new tissue which could re-block the artery.

But now surgeons will have to use the older "bare metal" stents instead.

The move was condemned last night by doctors from the British Cardiovascular Society.

Dr Nick Boon, its president, said: 'We are surprised, disappointed and very concerned by the preliminary guidance from NICE. Drug-eluting stents are expensive and we have never argued that it is appropriate to use them in all patients.

"We believe this NICE assessment is both perverse and flawed and intend to challenge these recommendations vigorously."

Dr Tony Gershlick, consultant cardiologist at University Hospitals Leicester, said NICE had underestimated the higher levels of risk in using the older "bare metal" stents and had used outof-date cost figures.

"Many thousands will need to come back for repeat procedures which will be associated with an element of clinical risk," he said.

Stents were introduced in the mid 1990s and mean a short stay of around a day in hospital, compared to more than a week following a bypass operation.

NICE deputy chief executive Andrea Sutcliffe said: "The independent appraisal committee has concluded that drug-eluting stents do not represent a costeffectiveuse of NHS resources. The decision was reached by a careful consideration of the evidence, taking into account the risks and benefits of the different types of stents, and the significant additional costs involved in the use of drug-eluting stents compared to bare metal stents."

A NICE spokesman admitted a review of clinical studies had shown that drug-eluting stents were 55 per cent more effective than bare metal stents in preventing narrowing of the arteries.

"But we weigh those benefits against the cost and whether we think the benefits justify the expenditure," she said. "The NHS should not waste money on treatments that are not worth it."

But Derek Holley of the British Cardiac Patients Association said: "How can you put a cost on people's health and life? I had a quadruple bypass 13 years ago and two of them failed so I have had two drug- eluted stents. They've saved my life."

Dr Duncan Dymond, consultant cardiologist at St Bartholomew's Hospital in London, added: "Here's another example showing that NICE acts not in the best interests of patients but in the best interests of the accountants, to reduce deficits."

The NICE guidance on stents for patients with coronary artery disease is in draft form only and will be subject to consultation until the end of the month. Final guidance will be issued in January next year.